Performance Improvement and Workforce Development

Resources for Public Health Practice

Ron Bialek

President Public Health Foundation 202-218-4420 rbialek@phf.org

Presentation Overview

• Introduction to the Public Health Foundation

• Why Now: Performance Improvement and Workforce Development?!?!

• Performance Management Framework

• Quality Improvement – Results that Matter – PHAB Domain 9 – Resources and Tools

• Workforce Development – The Future of Public Health – PHAB Domain 8 – Resources and Tools

PHF Mission

We improve the public’s health by strengthening the quality and performance of public health practice.

www.phf.org Healthy Practices Healthy People Healthy Places

Public Health Foundation: Helping Communities Achieve Better Results

• Performance Management/Quality Improvement (PM/QI) – Turning hard work into better results – Developing quality improvement tools – Helping people use PM/QI tools and methods – Expanding the evidence-base – Integrating science into practice

• Workforce Development – Fostering academic/practice linkages – Developing core competencies – Delivering, tracking, and evaluating training – Developing and tailoring training

Life Expectancy Drops for Some U.S. Women - April 22, 2008 Gap in Life Expectancy Widens for the Nation - March 23, 2008 U.S. Life Expectancy Lags Behind Other Countries - August 23, 2007 U.S. Slipping Down Life Expectancy Rankings - August 12, 2007 Healthcare Spending in U.S. Increased to $2.5 Trillion, Constituting 17.6 Percent of our GDP - August 1, 2011

Poll Question

What percentage of health care dollars is invested in public health? A. 12 percent of the healthcare dollar B. 8 percent of the healthcare dollar C. 4 percent of the healthcare dollar D. None of the above

Do we ACHIEVE desired RESULTS?

A few questions for you

• Are public health professionals working to improve the health of communities?

• Are public health professionals working really hard?

• Are we seeing the desired gains in health status in our communities?

• Are we doing the BEST we can with the limited resources we have?

Whassup?!?!?

“The definition of insanity is doing the same thing over and over and expecting different results.”

--- Rita Mae Brown (Sudden Death)

Turning Point Performance Management Framework

• Increasing need to demonstrate high performance and accountability.

• Performance management is the strategic use of performance standards, measures, progress reports, and ongoing quality improvement efforts to ensure an agency achieves desired results.

• In the case of public health, the ultimate purpose of these efforts is to improve the public’s health and make the community better to live in.

Source: From Silos to Systems: Using Performance Management to Improve Public Health Systems Prepared by the Public Health Foundation for the Performance Management National Excellence Collaborative, 2003

Poll Question

When it comes to performance management, my organization does this the most:

A. Establishes performance standards B. Selects performance measures C. Reports on progress D. Implements quality improvement processes

Poll Question

When it comes to performance management, my organization does this the least:

A. Establishes performance standards B. Selects performance measures C. Reports on progress D. Implements quality improvement processes

Focusing on Quality Improvement

Plan

Do Check

Act

• Uses many tools • Model often used in public health

Quality Improvement in Public Health?

• New ways to solve complex problems

• Getting the most value from out public health systems

• Show measurable results for what we do

Does QI Really Work in Public Health?

QI – Yes it works!

Reducing Syphilis in Orange County, Florida The causes of many public health problems may not be what you think. “Could Syphilis Be Linked to Office Gossip?”

QI – Yes it Works!

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Syphilis Data Source: Florida Department of Health, STDMIS System. 2006 data for all four counties provided as of 10/13/2006. *Peer county designation created by Community Health Status Indicators (CHSI) Project, HRSA, 2000, based on population density, size, and poverty levels. CHSI data notes are available at http://www.communityphind.net/CHSI-CompanionView.pdf.

QI – Yes it Works!!!

• Involved a diverse team • Set measurable targets

• Explored underlying

causes of problems

Diary of a Successful QI Team

• Mapped processes to identify improvement opportunities

• Focused on root causes, esp. staff turnover

• Brainstormed changes within their control or influence

• Kept action registers • Tracked monthly data

Diary of a Successful QI Team

• Reviewed progress as a team • Presented progress quarterly to

colleagues and management • Evaluated process • Celebrated team success, with local

health official recognition and certificates

QI – Yes it Works!

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Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3

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Syphilis Data Source: Florida Department of Health, STDMIS System. 2006 data for all four counties provided as of 10/13/2006. *Peer county designation created by Community Health Status Indicators (CHSI) Project, HRSA, 2000, based on population density, size, and poverty levels. CHSI data notes are available at http://www.communityphind.net/CHSI-CompanionView.pdf.

QI – Yes it Works!

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Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3

OrangeDuvalHillsboroughPinellas

2005 2006 2004

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Syphilis Data Source: Florida Department of Health, STDMIS System. 2006 data for all four counties provided as of 10/13/2006. *Peer county designation created by Community Health Status Indicators (CHSI) Project, HRSA, 2000, based on population density, size, and poverty levels. CHSI data notes are available at http://www.communityphind.net/CHSI-CompanionView.pdf.

QI – Yes it Works!

• Syphilis declined more than 25% • Improved and controlled processes underpinning the team’s

effectiveness • Achieved 100% conformance for field blood draw standards in

two consecutive months • Increased and maintained a cluster index above the CDC

standard (1.0) for four consecutive quarters • Stopped DIS staff turnover (a root cause)

• Achieved zero employee turnover in the first half of 2006 - 6 persons left the STD team in 2005

• Achieved full staffing for first time in group memory • Improved morale and teamwork

• Customer Satisfaction Surveys • Flow Diagrams – Patient Flow • Stop/Start/Continue Matrix

– START: Restrooms at end of process – CONTINUE: To not ask the patient all the questions about the

mist ("yes or no") if they know they want the shot.

QI – Yes it Works! (Northern Kentucky Independent District Health Department – H1N1 Experience)

QI – Yes it Works!

“…the Northern Kentucky Health Department’s clinic at an Independence middle school was so much more efficient than the check-out line at Target…

….Next year, I’m getting flu shots for everyone on my Christmas list.”

Lucy May, Senior Staff Writer Business Courier of Cincinnati November 30, 2009

Quality Improvement: Other Results that Matter

• Franklin, Hocking, and Summit Counties, OH – Increased childhood immunization rates by 24

percent

• Tacoma-Pierce County, WA – In three years, positive tests for chlamydia declined

by 23 percent

• Chronic Diseases – Childhood Asthma – Improved processes and coordination of public

health, primary care and schools

Performance Management and Quality Improvement: Resources and Tools

• Public Health Memory Jogger II • Public Health Quality Improvement Handbook • Journal of Public Health Management and

Practice • Pubic Health Improvement Resource Center – search by

PHAB domains, Essential Services, Performance Management Categories, Keywords

• Series of Topical Papers • Case Studies

www.phf.org

Performance Management and Quality Improvement Resources:

• Conduct a keyword search in the Public Health Improvement Resource Center (PHIRC) -http://www.phf.org/improvement/. Or search by PHAB Domains, Essential Services, Performance Management Categories.

• Turning Point Performance Management resources - http://www.phf.org/resourcestools/Pages/Turning_Point_Project_Publications.aspx

• Performance Management Self-Assessment Tool - http://www.phf.org/resourcestools/Documents/PM_Self_Assess_Tool.pdf

• QI Quick Guide and Tutorial - http://www.phf.org/resourcestools/Pages/QI_Quick_Guide.aspx

www.phf.org/resourcestools/Pages/Modular_kaizen_Dealing_with_Disruptions.aspx

Additional PM/QI Resources

• Online training modules – childhood obesity, strategy mapping – Access through TRAIN (www.train.org)

• National Public Health Performance Standards Program (http://www.cdc.gov/nphpsp/)

• National Public Health Improvement Initiative (http://www.cdc.gov/ostlts/performance/index.html)

• Workshops – ASQ, NALBOH, NACCHO, APHA

• PHF catalog of courses – training provided to over 100 state and local health departments

Public Health Workforce

“Many achievements in reducing mortality and morbidity during the past century can be traced directly to public health initiatives. The extent to which we are able to make additional improvements in the health of the public depends, in large part, upon the quality and preparedness of the public health workforce…” Institute of Medicine. Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century. National Academy Press, Washington, DC, 2003

Workforce Development Resources

• Council on Linkages Between Academia and Public Health Practice – Core Competencies for Public Health Professionals – Academic Health Department Learning Community

• TRAIN

• Other Partner and Federal Resources

Council on Linkages Between Academia and Public Health Practice

• Improve public health practice, education, and research by:

– Fostering, coordinating, and monitoring links among academia and the public health and healthcare community;

– Developing and advancing innovative strategies to build and strengthen public health infrastructure; and

– Creating a process for continuing public health education throughout one’s career.

19 National Public Health Organizations:

• American College of Preventive Medicine • American Public Health Association • Association for Prevention Teaching and Research • Association of Accredited Public Health Programs • Association of Public Health Laboratories • Association of Schools of Public Health • Association of State and Territorial Health Officials • Association of University Programs in Health Administration • Centers for Disease Control and Prevention • Community-Campus Partnerships for Health • Health Resources and Services Administration • National Association of County and City Health Officials • National Association of Local Boards of Health • National Environmental Health Association • National Library of Medicine • National Network of Public Health Institutes • National Public Health Leadership Development Network • Quad Council of Public Health Nursing Organizations • Society for Public Health Education

Funded by CDC and HRSA Staffed by PHF

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Core Competencies for Public Health Professionals

• Purpose: to help strengthen public health workforce development

• Describes desired knowledge and skills for the practice of public health in different settings and sectors

• Original Core Competencies adopted in 2001

• Re-visit every 3 years – no changes in 2004

• Major revisions in 2007 • September 11, 2001 • New technologies • Aging workforce

• Widespread use

• Demonstrated benefits and validity

• Desire for greater clarity and measurability

Does Anyone Really Care?!?!

• State Health Departments (SHDs)

• ASTHO reported in 2011 that more than 60 percent of SHDs are using the Core Competencies

• Local Health Departments (LHDs) • NACCHO’s 2010 profile study noted that nearly 30% of LHDs are using the Core

Competencies

• Academe • Results of a 2006 Council on Linkages survey showed that over 90% of academic

public health programs use the Core Competencies

• Federal Agencies • Centers for Disease Control and Prevention – developing discipline-specific

competencies and guiding training • Health Resources and Services Administration – needs assessments and training

programs offered by Public Health Training Centers

• Learning Management Systems for Public Health

The Core Competencies are Helping Organizations

• Develop • Job descriptions • Workforce competency assessments • Discipline-specific competencies • Training plans • Workforce development plans • Performance objectives • Continuing education programs

• Conduct • Curricula review and development • Performance reviews/evaluations

New Uses

• Accreditation • Core Competencies are incorporated into the Public Health

Accreditation Board (PHAB) standards

• Healthy People 2020 Objectives • Increase the proportion of Federal, Tribal, State, and local public health agencies

that incorporate Core Competencies for Public Health Professionals into job descriptions and performance evaluations.

• Increase the proportion of Tribal, State, and local public health personnel who receive continuing education consistent with the Core Competencies for Public Health Professionals (Developmental).

• Increase the proportion of Council on Education for Public Health (CEPH) accredited schools of public health, CEPH accredited academic programs, and schools of nursing (with a public health or community health component) that integrate Core Competencies for Public Health Professionals into curricula.

Core Competencies Tools

Tool: Crosswalks

• Crosswalk of the Core Competencies with the 10 Essential Public Health Services

• Crosswalk of the revised, tiered Core Competencies with the original Core Competencies

Tool: Job Descriptions

Sample job descriptions that incorporate the Core Competencies as key qualifications

Tool: Competencies Assessment

Tool to help assess gaps in skills and knowledge related to the Core Competencies and identify training needs

Tool: Examples that Demonstrate Attainment of Competence

Illustrations of how public health professionals can show competence in a specific area

Tool: Prioritization Matrix

Quality improvement tool to identify Core Competencies domains on which to focus attention and resources

Academic Health Department Learning Community

• National community of public health professionals learning about developing, maintaining, and expanding AHDs – Practitioners, educators, and researchers – Nearly 100 professionals from 27 states, DC, and 5 national

organizations

• Facilitates shared exploration of the AHD concept

• Encourages knowledge sharing and collaboration

Academic Health Department

• Affiliation of a health department and an academic health professions institution

• Public health’s version of the teaching hospital/medical school partnership

• Collaborative relationship to enhance public health education and training, research, and service

• Strengthens the linkages between academia and public health practice

AHD Learning Community Discussion

• Currently on the PHF Pulse Blog: – AHDs and the AHD Learning

Community – Steps in AHD Development – Model AHD Health Officer

Qualities – Translating Research into

Practice

• Posts written by Learning Community members

• Add your comments online at

http://www.phf.org/phfpulse

AHD Learning Community Profiles

• Personal profiles for AHD Learning Community members to share their experiences

• Available online

Council on Linkages Resources

• Core Competencies for Public Health Professionals – Competencies documents – Examples of uses and users – Tools • http://www.phf.org/programs/corecompetencies

• Academic Health Department Learning Community

– Concept paper – Profiles – Bibliography – Blog discussions – Tools (future) – Join the AHD Learning Community • http://www.phf.org/programs/AHDLC

Workforce Development Resources

TRAIN – Build a system for public health – Limit duplication – Maximize sharing and

learning

– Today • Nearly 500,000 registered

learners • Over 12,000 courses • Over 3,100 providers of

training • 22 states, MRC, and CDC

– www.train.org

Poll Question

I have used TRAIN

A. At least 5 times B. 1 to 5 times C. Only once D. Never

How might your use of TRAIN be increased? (Type your answer in the text chat box)

Other Workforce Development Resources

• Public Health Training Centers - www.asph.org/document.cfm?page=780

• CDC Learning Connection - www.cdc.gov/learning/ • Partners in Information Access for the Public Health

Workforce – www.phpartners.org • American Public Health Association – www.apha.org • National Association of County and City Health Officials –

www.naccho.org • National Network of Public Health Institutes – www.nnphi.org • Association of State and Territorial Health Officials –

www.astho.org • Association of Public Health Laboratories -

www.aphl.org/training/Pages/default.aspx

“ When you come to a fork in the road, take it.”

―Yogi Berra

Thank You!!!